The survival for a patient with Hodgkin's disease can be estimated based on the findings in 6 parameters at the time of diagnosis. Patients with a poor prognosis may benefit from more aggressive therapy.
Treatment protocol:
(1) stage IA: extended field radiotherapy
(2) stage IIA or IIIA with favorable histologic type (LP, NS): extended field radiotherapy
(3) stage IIA or IIIA with unfavorable histologic type (MC, LD): combined chemoradiotherapy or chemotherapy alone
(4) patients with B symptoms : combined chemoradiotherapy or chemotherapy alone
(5) stage IV: combined chemoradiotherapy or chemotherapy alone
(6) first step chemotherapy regimen: MOPP or COPP
(7) second step chemotherapy regimen: MOPP if at least 2 years had passed since the first regimen
(8) doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD) or MOPP alternating with ABVD were used as salvage therapy
Parameters at the time of diagnosis associated with prognosis:
(1) erythrocyte sedimentation rate
(2) age
(3) sex
(4) serum albumin
(5) clinical stage
(6) histologic type of Hodgkin's disease
Parameter |
Finding |
Score |
erythrocyte sedimentation rate (ESR) |
<= 45 mm per hr |
0 |
|
> 45 mm per hr |
1 |
stage |
I or II |
0 |
|
III or IV |
1 |
histologic type |
lymphocyte predominant (LP), or nodular sclerosing (NS) |
0 |
|
mixed cellularity (MC), or lymphocyte depleted (LD) |
1 |
age |
< 45 years |
0 |
|
>= 45 years |
1 |
albumin |
<= 3.5 g/dL |
1 |
|
> 3.5 g/dL |
0 |
sex |
male |
1 |
|
female |
0 |
expected mean survival time in months =
= 329.5 - (64 * (ESR score)) - (70.6 * (stage score)) - (60.2 * (histologic type score)) - (40.4 * (age score)) - (29.9 * (albumin score)) - (24.3 * (sex score))
Interpretation:
• maximum survival by equation (all favorable): 329.5 months (27 years)
• minimum survival by equation (all unfavorable factors): 40.1 months
• 5 year survival with all favorable factors: about 85%
• 5 year survival with all unfavorable factors: 20%
Limitations:
• Survival would be affected by treatment protocols, so that patients treated with different protocols or newer agents may have different survivals.
Specialty: Hematology Oncology